April 12, 2012

Image of the Day 3: Urine Discoloration

In approaching patient with urine discoloration, it is very important to distinguish whether the urine discoloration is caused by hematuria or non hematuria urine discoloration.

Hematuria could be due to many causes either from systemic, renal, ureter, bladder, prostate or urethra. It signifies a serious condition and need a very serious attention.

In a meantime, it is important not to confuse yourself with a non hematuria causes of urine discoloration which of course less important as compared to haematuria. Urine discoloration could be due to many things starting from concentrated urine, increase in tissue breakdown that release myoglobin, dye, diet and drugs.

This picture highlight an orange urine discoloration in a patient with TB spine who receive Rifampicin.

Rifampicin is a broad spectrum bactericidal antibiotic which inhibit the synthesis of bacterial RNA by binding to the beta subunit of the DNA- dependent RNA polymerase. This will block the transcription of the RNA.

This traditional antibiotic has been used since ages to treat tuberculosis, leprosy and oppurtunistic mycobacterial infection.


  1. salam dr naim.. how to differentiate hematuria based on location?
    and how to know in the history taking if the hematuria cause by the increase in tissue breakdown that release myoglobin?

  2. 1) Hematuria arising from urethral injury usually come first before urination and at the end of urination phase..Gross hematuria with clot usually arise from bladder.and hematuria throughout the urination is basically from the higher up lesion.. present of cast usually indicate that the hematuria is from the kidney.....

    2) Rarely myoglobinuria is caused by congenital metabolic disease or connective tissue disease.. most of the time, it is caused by trauma or anything that can cause muscle destruction.therefore it's applied to any history of MVA especialy crush and compression injury, any vascular injury and recent surgery .. so it's pretty straight forward. other history that should be elicited includes alcohol overdose, drug overdose, fitting episodes.

  3. I'm 4th year student from unisza..I hv a patient, a 55 yo presented with gross hematuria and hd been diagnose with bph..how come bph causing hematuria? What is d possible cause of this pt?

  4. Any obstruction can cause irritation to the urethral and injured it causing the hematuria.same pathophysiology for BPH. but in older age pt, you need to look hard for any malignancy of the genitourinary tract.. simple approach is to do the KUB x ray first to look for any stones..then proceed with Ultrasound.. if there's feature to suggest obstruction, then proceed with IVU or retrograde urogram..

    and of course never forget to take the PSA and full examination


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